Biochemical effects of occupational diagnostic ionizing radiation exposure on medical radiographers: AI-assisted exploratory radiation biological effect score (RBES)

Medical radiographers are chronically exposed to low-dose ionizing radiation during diagnostic imaging procedures, raising concerns about the cumulative biological effects of prolonged occupational exposure despite adherence to international radiation protection standards. This comparative cross-sectional study evaluated hematological, biochemical, immunological, and oxidative stress biomarkers in 25 occupationally exposed radiographers and 25 hospital-based non-occupationally exposed controls from Kirkuk, Iraq. Ambient workplace gamma dose rates were measured using a calibrated Geiger–Müller survey meter to characterize the occupational radiation environment. Venous blood samples were analyzed for red blood cells (RBC), white blood cells (WBC), platelets (PLT), alanine aminotransferase (ALT), aspartate aminotransferase (AST), immunoglobulin A (IgA), immunoglobulin G (IgG), and malondialdehyde (MDA). An exploratory AI-assisted Radiation Biological Effect Score (RBES) was developed by integrating normalized biomarker values into a composite biological risk framework. Compared with controls, occupationally exposed radiographers showed significantly lower RBC, WBC, PLT, IgA, and IgG levels and significantly higher AST, ALT, and MDA concentrations (all p < 0.001). Estimated annual ambient radiation doses ranged from 1.23 to 7.36 mSv/year, and the RBES classified 28% of participants as low risk, 64% as moderate risk, and 8% as high risk. These findings suggest that prolonged occupational exposure to diagnostic ionizing radiation is associated with alterations in hematological, biochemical, immunological, and oxidative stress biomarkers. However, because of the cross-sectional design, limited sample size, absence of individual cumulative dosimetry, and potential residual confounding, these findings should be interpreted cautiously. The exploratory RBES requires validation in larger prospective multicenter studies before routine occupational health application.